A journey through policy, progress, and being a patient by Kate Steadman

November 28, 2005

Whence and Wither Flu Shots

You all might remember my post asking for advice about getting a flu shot. I never called around trying to find one, which is apparently a good thing because I might have had some trouble:

Three in four doctors responding to a California Medical Association survey had not received their full vaccine supplies as of Nov. 3. More than half of them had not obtained any vaccine, and 70 percent had to reject high-risk patients' requests for flu shots.

What went wrong? According to the Union-Tribune article, vaccine manufacturers preferentially shipped supplies of vaccine to high-volume customers, like big-box stores such as Costco, Wal-Mart, and Albertsons on the west coast of the US. Quoting Dr. Wayne True, a physician in La Mesa, "This year's vaccines are going to where the money is - to the 'big box' customers first." Physicians often "go through pharmaceutical distributors for their vaccine supplies, while some big retailers are able to place bulk orders directly from vaccine manufacturers.

So, last year there wasn't enough vaccine, and this year we're making sure non-medical locations receive it first?

A reader sent me an email describing the same problem this weekend. He has a small practice in Pennsylvania and has also had a difficult time attaining vaccines:

For my practice, I was unable to purchase AT ANY PRICE 30-40 shots which would have been all I needed, and the health departments also have had to cancel their shot clinics too, even for the senior centers.

For young and healthy (like me), it's easy to head over to Costco or the grocery store to get a flu shot. The elderly depend on their local docs. And they need these flu shots the most. My close friend's grandfather was just hospitalized with pneumonia. Getting these people preventative care is vital, and for many of them it's a matter of life and death.

Roy Poses, who authored the original post at Health Care Renewal, expresses this sentiment eloquently:

As a physician, it seems to me that the true measure of a health care system is how it takes care of the sickest and neediest patients. Here we have a system that can supply influenza vaccine to relatively healthy people who show up at big-box stores, but not to sick, high-risk patients in doctors' offices.

This problem is also a consequence of free-market policies in relation to health care, and a perfect example of why CDHC proponents are wrong. The market, in this case (and many others related to health care) rewarded those with the most money and reduced access for the sickest and most immobile people. That's not wrong from the market's standpoint -- certainly it's serving its function. But people need more in this situation, and that's why we have regulated markets. When it comes to health care, those regulations provide essential protection so people don't die from the flu because their doctor couldn't order flu shots. It's really that simple, and breaking down competition barriers won't help a smidgen when big box retailers are providing health products.

Update: I was at the doctor's office today and, sure enough, there was a sign on the door saying they don't have any flu shots this season because the manufacturer wouldn't deliver them until December, so they cancelled the order.